Quantifying Real-World Community Mobility and Social Interaction of Individuals after Stroke Using Mobile Phone Technology
(Project D1, R3: Mobility)
Arun Jayaraman, PT, PhD
Stroke is the leading cause of adult-onset of disability. Returning to prior levels of function, specifically independent mobility both at home and in the community, remains a priority to most stroke survivors. In addition, recovery of mobility is a significant factor in determining the level of disability following stroke. For non-institutionalized stroke survivors living in the United States, rehabilitation is focused on physical therapy interventions aimed at improving mobility and walking performance. The overall goal is to reintegrate stroke survivors into society, employment, and economic and social independence. However, development of therapeutic interventions is limited by a lack of quantitative, informative outcome measures.
Currently, self-selected walking speed is considered the most important measure of stroke rehabilitation and is thought to be a predictor of health status, community mobility, social interaction, and overall quality of life.
However, numerous advanced therapeutic interventions for stroke survivors have not resulted in statistically significant changes in walking speed. This suggests that walking speed might not be a sensitive enough measure to quantify all functional improvements following therapy. Furthermore, deficits in balance, coordination, and cognition and visuospatial changes that affect mobility following stroke may not be reflected by gait speed measures. Stroke is a very heterogeneous condition with a large population of non-ambulatory stroke survivors who use assistive technology for mobility in the community but would be deemed non-mobile if evaluated using gait speed. Finally, community and home mobility are affected by other social, environmental, and personal factors. Thus, to determine the effectiveness of rehabilitation interventions following stroke, there is a compelling need to accurately quantify mobility and assess social interactions at home and in the community.
The objective of this proposal is to demonstrate the feasibility of using smart phone technology to create a quantitative outcome tool. We will create a mobile-phone application (app) to assess real-world mobility and social interactions within the community, and we will evaluate this app in a cohort of stroke survivors.
Approximately 795,000 individuals are diagnosed with stroke each year; currently there are more than 6.4 million non-institutionalized stroke survivors in the United States. Our study will focus on measuring home and community mobility in stroke survivors; however, the mobile phone technology we develop could be used in any population of individuals with any mobility-limiting disability.